Provider Demographics
NPI:1477554491
Name:RUDDEN, JERRY NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:NEIL
Last Name:RUDDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 GEORGIA AVE
Mailing Address - Street 2:SUITE #304
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5006
Mailing Address - Country:US
Mailing Address - Phone:301-681-8500
Mailing Address - Fax:301-681-8502
Practice Address - Street 1:10313 GEORGIA AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5006
Practice Address - Country:US
Practice Address - Phone:301-681-8500
Practice Address - Fax:301-681-8502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD61771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice